In every case of milk indigestion, we should' inquire carefully as to the time of feeding, the quantity supplied at each meal, and the attention be stowed upon cleanliness in the feeding apparatus.
The inability to digest cow's milk may be a natural peculiarity of the infant, or a merely temporary incapacity arising from a disordered state of the digestive organs. In the first case, if a wet-nurse cannot be procured, or is objected to, we may give the milk of the goat or ass. Either of these is usually well digested by children who find cow's milk too heavy. The addition of a third or fourth part of barley-water still further increases the digestibility of the meal, and Mellin's food may be dissolved in the mixture with advantage. Both these milks should be boiled before being used. Ass's milk sometimes has laxative properties which boiling will remove. By the same means the strong flavour of goat's milk may be diminished, although this is often not objected to by the infant. An aromatic, such as a couple of teaspoonfuls of cinnamon water, added to the milk, seems often to supply a stimulus to digestion ; and I have known infants who were invariably troubled with flatulence and discomfort after a meal of plain cow's milk and barley-water, digest perfectly the same mixture when thus aromatised. If test paper show slight acidity of the milk, a pinch of bi carbonate of soda should be always added to the bottle.
Condensed milk is often recommended in these cases, and is usually well digested, but the nourishment it supplies is very insufficient for a growing baby. The child may get fat, but is usually lethargic and dull. Although big, he is not strong ; and unless the milk be largely supplemented by Mellin's food, the infant will probably drift into rickets before he is seven or eight months old. The seine may be said of the other foods con taining preserved milk, as Nestle's and Oettli's Swiss milk food. They are often more easily digested than undiluted cow's milk, but after the first few months should not be relied upon to supply the whole nourish ment of the baby. In all cases it is advisable to revert to fresh cow's milk as soon as this can be done with safety. There Is another reason why an infant should not be allowed to derive his whole nourishment from tinned and preserved foods. It is now a recognised fact that hand-fed babies are liable to a form of scurvy ; and if the child be entirely deprived of fresh milk and other anti-scorbutic foods, this consequence of injudicious feeding is very likely to be brought about (see page 253).
It is in cases where ordinary cow's milk is digested with difficulty that Dr. Robert's plan of pancreatising the milk is so valuable. Pancreatised milk is prepared in the following way :—To a pint of new cove's milk is added half a pint of boiling water, two teaspoonfuls of Benger's pancreatic solution, and twenty grains of bicarbonate of soda dissolved in a little water. The whole is stirred up in a jug, which is afterwards covered, and then placed in a warm situation under a " cosey." At the end of an hour, the contents of the jug are emptied into a sauce-pan, and the mixture is boiled for two minutes to stop further action of the pancreatine upon the milk. The food is then ready for use. It may be sweetened to the child's taste with sugar of milk. In milk so prepared, the casein is peptonised by the action of the pancreatine, and the main difficulty in the digestion of the milk is removed. This method is, in my opinion, far preferable to that suggested by Prof. Frankland. In the latter method (artificial human milk), the cove's milk is diluted with a third part of whey, and no doubt by this means the normal proportion of casein in woman's milk may be exactly imitated ; but the process does nothing to render the stiff curd more di gestible, and the firm clotting Of the casein is just the difficulty which it is so essential to overcome.
A temporary incapacity for digesting milk on account of gastric de rangement, is a common phenomenon iu the young child, and, indeed, is the most frequent cause of failure iu hand-feeding. If a change be not made in a diet which evidently disagrees, it is not long before a catarrh of the gastric mucous membrane becomes established. This derange ment, when once confirmed, is not always easy to control, and, if very stringent measures are not promptly taken, may lead to the death of the child. A mild form of gastric disturbance sufficient to prevent the diges tion of milk, is not unfrequently met with, even in children at the breast. It is indicated by a sour smell from the mouth, a slight sallow tinge of the skin, and by the vomiting of each meal directly after it has been swallowed. Sometimes the bowels are relaxed, from participation of the intestinal mucous membrane in the derangement. A condition such as this may exist almost from birth. It is a common accident in hand-fed babies, and if neglected, leads, as has been said, to serious and perhaps fatal conse quences.